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World J Transplant. Sep 18, 2024; 14(3): 96637
Published online Sep 18, 2024. doi: 10.5500/wjt.v14.i3.96637
Challenges related to clinical decision-making in hepatocellular carcinoma recurrence post-liver transplantation: Is there a hope?
Nourhan Badwei
Nourhan Badwei, Department of Tropical Medicine, Gastroenterology and Hepatology, Hepatoma Group, Ain Shams University, Cairo 11517, Egypt
Author contributions: Badwei N contributed to collecting, designing the research data, and writing the manuscript with critical final revision and editing.
Conflict-of-interest statement: The author declares no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nourhan Badwei, MD, PhD, Lecturer, Department of Tropical Medicine, Gastroenterology and Hepatology, Hepatoma Group, Ain Shams University, Abbasiya Street, Cairo 11517, Egypt. nourhanbadwei1990@gmail.com
Received: May 11, 2024
Revised: June 8, 2024
Accepted: June 24, 2024
Published online: September 18, 2024
Processing time: 80 Days and 16.8 Hours
Abstract

Hepatocellular carcinoma (HCC) is a common liver malignancy and represents a serious cause of cancer-related mortality and morbidity. One of the favourable curative surgical therapeutic options for HCC is liver transplantation (LT) in selected patients fulfilling the known standard Milan/University of California San Francisco criteria which have shown better outcomes and longer-term survival. Despite careful adherence to the strict HCC selection criteria for LT in different transplant centres, the recurrence rate still occurs which could negatively affect HCC patients’ survival. Hence HCC recurrence post-LT could predict patients’ survival and prognosis, depending on the exact timing of recurrence after LT (early or late), and whether intra/extrahepatic HCC recurrence. Several factors may aid in such a complication, particularly tumour-related criteria including larger sizes, higher grades or poor tumour differentiation, microvascular invasion, and elevated serum alpha-fetoprotein. Therefore, managing such cases is challenging, different therapeutic options have been proposed, including curative surgical and ablative treatments that have shown better outcomes, compared to the palliative locoregional and systemic therapies, which may be helpful in those with unresectable tumour burden. To handle all these issues in our review.

Keywords: Hepatocellular carcinoma; Recurrence; Liver transplantation; Prognosis; Clinical decisions; Management

Core Tip: In this review, challenges and debates related to the management of hepatocellular carcinoma recurrence after liver transplantation (LT) were carefully handled, discussing the risk factors, pre/post-LT prediction models of tumour recurrence, and different therapeutic approaches either curative or ablative in the settings of post-LT immunosuppression.